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RET 重排 NSCLC 对 RET 抑制的耐药性是由 RAS/MAPK 信号的再激活介导的。

Resistance to RET-Inhibition in RET-Rearranged NSCLC Is Mediated By Reactivation of RAS/MAPK Signaling.

机构信息

Division of Medical Oncology, or.

Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.

出版信息

Mol Cancer Ther. 2017 Aug;16(8):1623-1633. doi: 10.1158/1535-7163.MCT-17-0008. Epub 2017 May 12.

Abstract

Oncogenic rearrangements in are present in 1%-2% of lung adenocarcinoma patients. Ponatinib is a multi-kinase inhibitor with low-nanomolar potency against the RET kinase domain. Here, we demonstrate that ponatinib exhibits potent antiproliferative activity in RET fusion-positive LC-2/ad lung adenocarcinoma cells and inhibits phosphorylation of the RET fusion protein and signaling through ERK1/2 and AKT. Using distinct dose escalation strategies, two ponatinib-resistant LC-2/ad cell lines, PR1 and PR2, were derived. PR1 and PR2 cell lines retained expression, but not phosphorylation of the RET fusion and lacked evidence of a resistance mutation in the RET kinase domain. Both resistant lines retained activation of the MAPK pathway. Next-generation RNA sequencing revealed an oncogenic NRAS p.Q61K mutation in the PR1 cell. PR1 cell proliferation was preferentially sensitive to siRNA knockdown of NRAS compared with knockdown of RET, more sensitive to MEK inhibition than the parental line, and NRAS dependence was maintained in the absence of chronic RET inhibition. Expression of NRAS p.Q61K in RET fusion expressing TPC1 cells conferred resistance to ponatinib. PR2 cells exhibited increased expression of EGFR and AXL. EGFR inhibition decreased cell proliferation and phosphorylation of ERK1/2 and AKT in PR2 cells, but not LC-2/ad cells. Although AXL inhibition enhanced PR2 sensitivity to afatinib, it was unable to decrease cell proliferation by itself. Thus, EGFR and AXL cooperatively rescued signaling from RET inhibition in the PR2 cells. Collectively, these findings demonstrate that resistance to ponatinib in RET-rearranged lung adenocarcinoma is mediated by bypass signaling mechanisms that result in restored RAS/MAPK activation. .

摘要

在 1%-2%的肺腺癌患者中存在 的致癌重排。帕纳替尼是一种多激酶抑制剂,对 RET 激酶结构域具有低纳摩尔效力。在这里,我们证明帕纳替尼在 RET 融合阳性 LC-2/ad 肺腺癌细胞中表现出强大的抗增殖活性,并抑制 RET 融合蛋白的磷酸化以及通过 ERK1/2 和 AKT 的信号传导。使用不同的剂量递增策略,衍生出了两种帕纳替尼耐药的 LC-2/ad 细胞系 PR1 和 PR2。PR1 和 PR2 细胞系保留了 RET 融合的表达,但不保留其磷酸化,并且在 RET 激酶结构域中缺乏耐药突变的证据。这两种耐药系均保留了 MAPK 通路的激活。下一代 RNA 测序显示 PR1 细胞中存在致癌 NRAS p.Q61K 突变。与 RET 敲低相比,PR1 细胞的增殖对 NRAS 的 siRNA 敲低更敏感,对 MEK 抑制比亲本系更敏感,并且在没有慢性 RET 抑制的情况下维持 NRAS 依赖性。在表达 RET 融合的 TPC1 细胞中表达 NRAS p.Q61K 赋予对帕纳替尼的耐药性。PR2 细胞表现出 EGFR 和 AXL 的表达增加。EGFR 抑制降低了 PR2 细胞中 ERK1/2 和 AKT 的磷酸化和增殖,但对 LC-2/ad 细胞没有影响。虽然 AXL 抑制增强了 PR2 对阿法替尼的敏感性,但它本身并不能降低细胞增殖。因此,EGFR 和 AXL 协同作用恢复了 PR2 细胞中 RET 抑制后的信号传导。总之,这些发现表明,RET 重排肺腺癌对帕纳替尼的耐药性是由旁路信号机制介导的,这些机制导致 RAS/MAPK 激活的恢复。

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